Anticoag chart for mid-levels?
Started by Baron S
University of Washington has a useful chart based on procedure type
The one I found looks a bit unnecessarily conservative. It looks like they are holding just about everything for even low risk procedures.
Mind posting?
Copy of mine
ill see if i can export it to a pdf
thats b/c they are all based on the ASRA guidelines which are pretty much useless
i think ASIPP is a bit more liberal
Advertisement - Members don't see this ad
Here’s mine for bread and butter stuff:
Nothing needs to be held unless we’re entering the interlaminar space (in which case we’ll pick another approach 99% of the time anyway).
Nothing needs to be held unless we’re entering the interlaminar space (in which case we’ll pick another approach 99% of the time anyway).
I thought you don’t hold for most things?
Or is this just for stuff like kypho/scs and interlam?
Scs, kypho. Some cesi.
They are. Nuanced enough to make it confusing and hard to use. They stratify low, medium and high risk. High lumbar TFESI is higher risk than low lumbar. ASIPP guideline makes more sense than ASRA guideline, just a bit cumbersome.
Would like to see IPSIS come with something more definitive.
Some CESI?
Well, of you hold ACAP, will they be at higher risk for epidural hematoma, or will they be a higher risk for catastrophic thromboembolism?
IMO, for IL ESI, SGB, and advanced procedures, certainly warrants a risks/benefits discussion with the patient and communication with the ACAP prescriber to CYA.
Even then, exact risk for epidural hematoma is very hard to determine, since these are such incredible rare events, and the power needed to determine the risk is infeasible. Studies that tell us "we injected 4000 patients on ACAP and no one had an epidural hematoma" aren't helpful, when we already know the risk less than 1/4000 to begin with.
And this is why I don't think I'd ever be comfortable with simply using an "algorithm." Each patient's risk profile and expected potential benefit from the procedure is different.
Last edited:
Rational thoughts. Based in science. 🤓
Are a lot of you guys restarting these meds 6 hrs after the epidural or just restarting the next day
Last edited:
In general, I follow the ASRA guidelines. Of course it matters what the specific med is, but for the majority of the meds the ASRA guidelines call for re-starting the meds 24 hours after the procedure.
that evening. ASRA guidelines are a recipe for disaster.
Advertisement - Members don't see this ad
